Cultural Adaptation and Psychometric Properties of the Persian Version of the Affordance in the Home Environment for Motor Development.

Objectives This study aimed to translate the Affordance in the Home Environment for Motor Development (AHEMD) scales (3-18 months (IS) and 18-42 month (SR) versions) into Persian and examine its cultural adaptation and psychometric properties. Materials & Methods Four stages process was conducted as translation of the questionnaires (use of International Quality of Life Assessment protocol), cultural adaptation, and determination of its psychometric properties. Qualitative judgments were provided by 11 experts and 30 mothers for interview sessions. Quantitative data were gathered using 212 mothers. Results For the IS version, validity values ranged from 0.63 to 0.95. Intraclass correlation coefficient for reliability of total score was 0.87 (0.83-0.97) and was Cronbach’s alpha (0.75). Validity for the AHEMD-SR ranged from 0.63 to 0.90, with reliability for total score of 0.98 (0.98-0.99, ICC). Cronbach’s alpha for this version was 0.84. Correlations with SES were significant for both scales: IS (r = 0.40) and AHEMD-SR (r = 0.42). Conclusion Both translated versions of the AHEMD were valid and reliable assessments of the home environment of Iranian young children.


Introduction
Child motor development is a complex process which results from the interaction between genetics, epigenetics, and the environment (1)(2)(3). The role of the home as the first environment for child experiences is very important for motor development, especially during infancy (4). Thus, a more supportive and stimulating environment is associated with more affordances and challenges for infant motor development that may lead to improvement in social and cognitive development (5). With regards to special populations, one out of six children has a developmental disorder caused by various factors, one of which can be environmental deprivation and lack of a stimulating home environment (6,7).
An effective home environment includes educational and learning materials (e.g., toys, books), space, and stimulation from family members. All of which, have been shown to influence a child's motor, cognitive and other behavioral aspects of development (8). From the Gibsonian viewpoint, an ecological approach, the environment is referred to as "resources and opportunities for action".
Children learn by interacting with their environment as well as events and incidences (9). What the environment provides and offers to animals or organisms is called an "affordance". In other words, opportunities (e.g., toys, equipment, events, space) that provide a stimulating link between the environment and organism to create a meaningful behavior. Affordances include the type of space we move in, the cup we drink from, and ways that we can manipulate a toy or piece of equipment (10)(11)(12). Regarding assessment of the home environment, the Home Observation for Measurement of the Environment (HOME) Inventory was developed to investigate demographic and socioeconomic sta-tus characteristics of families, and the relationship between the home environment, social, emotional, and cognitive development in children. The HOME was organized along six different dimensions including 1) responsivity, 2) acceptance, 3) organization, 4) learning materials, 5) involvement, and 6) variety. Although the dimension of "learning materials" and "organization" in the HOME to some extent can be related to motor development, this questionnaire was not designed to appropriately examine the relationship between motor affordances and home environment (13,14). The Affordance in the Home Environment for Motor Development-Self Report (AHEMD-SR) was created in 2005 for ages 18 to 42 months, and more recently a version for ages 3 to 18 months (AHEMD-Infant Scale (IS)) was validated for use. As of with writing, the original English versions have been translated into eight languages and reported as valid and reliable in countries such as China, Poland, Lebanon, and Italy (15)(16)(17).
The population of children 4 yr old in Iran is estimated to be 3.5 million (18). Of that population, approximately 10% have developmental disorders (19). Fine-and gross motor skills, compared to US norms, were significantly lower in Iranian children under 4 yr of age. In those reports, one possible explanation for the differences was lack of motor affordances in the home (15,20). However, there is little of any empirical evidence to support such an assumption. We aimed to modify the AHEMD (both versions) for using with Iranian children. Our objectives were: translate to Persian and examine its cultural adaptation and psychometric properties.

Materials & Methods
Creation of the Persian versions of the AHEMD Cultural Adaptation and Psychometric Properties of the Persian Version of the Affordance... was conducted in the following four phases.

Phase 1. Translating the questionnaires
To translate the two questionnaires, we used the International Quality of Life Assessment (IQOLA) protocol (21). First, the original versions were translated from English to Persian by two translators, who were also experts in activities related to children (one was also an occupational therapist).
After completion of the forward translation, both Persian translations were merged and a single translation for each questionnaire was created. For Convergent validity, the relationship between each questionnaire and SES were evaluated using Pearson's and Spearman's rank correlation method. Significant level was set at 0.05.

Ethical consideration
Informed consent was obtained from all parents participated in the project. Ethics Committee of the university approved the study as number # 912502005.

Significant correlations were found between SES
and some subtests of the AHEMD-IS, including GMT, PS and FMT. The correlation between SES and VS was not significant ( Table 2). For the AHEMD-SR, the only significant correlations were between SES and IS and SES and GMT.
ANOVA results showed that total scores of both the AHEMD-IS and AHEMD-SR were significantly different between the four SES groups ( Table 2). Reliability of AHEMD-IS and AHEMD-SR. Internal consistency of all subtests of both questionnaires ranged between 0.61-0.97. Results of the ICC showed high test-retest reliability ( Table 2).

SES: Social Economic Status
Cultural Adaptation and Psychometric Properties of the Persian Version of the Affordance...    In AHEMD-IS, subtest of GMT that considered for